Did i answer all your questions . Im curious to know more about the data you plan to gather, when you feel you might have some results. And again, whether you feel there will be barriers in terms of staffing and actually physical placement that might slow down your progress. So i think what youre getting at with the whole person care funding ending in 2020 and our target date to open the Homeless Health resource center, which will be the clinical home or hub of whole person integrated care, that will be in late 2021, so within the next year. I mean, what this really does is it i dont want to overuse the word foundational, but it lays the foundation for us to be working together across Clinical Services to determine what the need is for people showing up to urgent care repeatedly, but they might have one of the Street Team Members or the hot case manager working with them. What it does is brings people together to develop a care model so that theyre actually coordinating care for these folks. Were starting now. Weve already started this work, so were already starting the case conferencing and then working across these existing Clinical Services with the whole person care team on the shared priority list. Thank you. Director cofax. I want to thank both dr. Hammer and ms. Martinez for their incredible work on this and just to emphasize that the literature shows that people suffering from these conditions with support and not as much support as some of us might think is necessary can be housed. I think one of the wonderful aspects of ms. Martinezs leadership is shes brought in a number of researchers and clinicians from ucsf, several of them leaders in this field to bring in a healthbased aspect to this work. This is an effort thats going to be saving lives Going Forward. I mean, the specific when we open hub and how that happens are important pieces. I want to emphasize we are doing this now and Going Forward. This is really a continuation of our modernizing our system of Behavioural Health care in response to data so we make the investments Going Forward to get those people in the housing and get them the Wraparound Services we know they need. Thanks. I wanted to add an example of that, commissioner green. So just as an example of this sort of working across previously disparate services is we have a psychiatric nursepractitioner from the Behavioural Health access team who now basically has jumped and is embedded working with the street medicine team. Thats just an example of bringing our staff together who all touch in different ways this patient population, these patients, these individuals theyre not all patients, and connecting them to services. So he has in a expertise that he can assess people on the street and is an expert in access and how to access our services. So first of all, ms. Martinez, dr. Hammer, i would like to associate myself with the comments made by fellow commissioners about your excellent presentation. Thank you. Since youre nimble going back and forth on slides, i had questions on three of them starting with this slide here. I know our focus is on Behavioural Health and Substance Use disorders now, but noticing on the slide that 74 have a serious medical condition, 12 h. I. V. aids, 35 hypertension, 4 renal failure. Skipping forward three slides to this slide here and looking at the coordinated entry assessment, im wondering at what point do these factors enter into prioritizing people for housing and other things . Because as we know, housing stability contributes to Better Health outcomes, whether its someone with h. I. V. And adhering to their regimen, Blood Pressure monitoring, sticking to a diet, those things are very important. Does that come into the Assessment Tool at all . Yes. And also skipping forward a few more slides to the outcomes, is there anything in the outcomes that youre measuring when it comes to Health Outcomes when it comes to these other conditions people have . Good point on that last question. I would say that when i first looked at the coordinated entry Assessment Tool, i know all of the 6,000some people who have been assessed and all the 1,000 of those people who were prioritized. So essentially what i did is i looked at what the data said. Did they assess a pretty good representation mix of who we know are experiencing homelessness . Yes, on every single count, the representation of the people in the jail, also the people who so like 25 of the general population have a jail history, about 25 of those assessed had a jail history. I looked at about 14 or 15 of those vulnerabilities, and all of them were very well represented with the exception of psychosis, and that makes sense. Then i looked at who got prioritiz prioritized and it was significant higher. One of them was medical. So significant higher of those who did get prioritized showed up. So their tool is identifying through the questions they ask, which does ask about some medical conditions, are identifying and prioritizing them and the way we wish to see it with the exception psychoses, and we will be working with them. Also, i believe i had seen a previous presentation getting to zero on this Assessment Tool. Do i understand correctly you dont draw the curtain all the way back on what the criteria are because sometimes someone whos working with an individual client, for example, might coach answers to advantage somebody in the yeah, i think that there was a lot of suspicion around whether or not the tool asked the right question, did the right ranking, whatever. What i have experienced is that is sort of set aside. When i said no, i validated the how many people were assessed, representative, and their vulnerability, and i dont get those questions as much at all, actually. All right. Thank you. So in terms of the impact on their medical stability, i think that its pretty much assumed that we will be able to begin to address their medical conditions, but i think its a good idea to measure the impact. I would like to see that. I dont want to bombard you with more questions, but i think it sounded to me like eventually youre going to set some indicators so that you know how to measure the progress of the program and its hard to like, just being here and pull some numbers out of your head and saying this is the goal, so i totally understand that. Im curious about how you will be integrating Harm Reduction philosophy into the program, because, as you mentioned, these are clients with lots of different Behavioural Health issues. Some of them may need to access sobering center. Even as theyre housed, what type of housing would that be . That is another big barriers that a lot of them had challenges with is to stay sober while theyre housed. If theyre in facilities that are like only in the abstinence model, how are they going to be able to maintain . And also the other issue is how are they going to pay for the housing . I think thats the other issue that is commonly faced by this population which in my old days it was the program. If they dont have the money manager that sets the money aside, then its really difficult for them to exercise their own independence because of some of the cooccurring issues that theyre facing. So one aspect of the streettohome plan for everyone will be around benefits. So we are talking to our ssic program that was set up in the Mental Health department so we can get these folks into s. S. I. Advocacy so they can get the income that they need. I think the system Response Team which met again on friday is getting ideas and issues from the Provider Team that are working with the 237 and theyre developing their streettohome plan. Thats getting in the way of them getting there could very well be that they need a level of care in housing that we dont yet have. So thats a recommendation. It could be that they need a service where there are not enough slots. Thats a recommendation. It could be that we have slots, but being there tuesday at 4 00 p. M. Just does not work for this so there could be very many things that are coming to that system Response Team of people who are going to say this is the way we need to proceed. So do we need a different kind of service or a different kind of housing that we dont have . A number of the people have sex offender histories where we cant so what are the hurdles and the challenges of getting people from here to there . We may not be able to solve all of them, but we are trying to figure out what we can empower the Provider Team to solve on their own, versus where they need someone to unjam that, versus what needs to come to grant in the Health Commission and think about long term. Thank you. I think thats helpful. Commissioner chow. Yes, as we were looking at the serious medical conditions, i was just wondering how we were going to be connecting for these. Im sure youre going to have Substance Abuse programs and psychiatric programs. There are clinics that would be managing some of the worst of the worst. What would be the connections that we would be doing or encouraging . Would we actually be putting them into those or were going to have this as sort of a selfcontained medical system thats doing primary care and and im not sure then where some of the more serious issues requires secondary or tertiary consultation would come in. The integrated approach for whole person care is based on the work of the medical director of street medicine. What weve been working on is what hes termed a transitional primary care approach. So we have excellent brickandmortar primary care centers all over the cities, as you know. Yet, these programs that were bringing together as whole person integrated care are really built to serve the needs of people who are less likely to engage in that sort of traditional primary care model. So we see them in shelters, we see them in Supportive Housing sites, we see them on the streets or in urgent care. The goal is really to as were engaging them and treating their whole person from things we didnt mention, dental, podiatry, as well as their chronic medical conditions, identifying what their needs are. And we have a lot of expertise in our system, figuring out what how we get them to the care that they need. So i have a lot of confidence in our ability to be innovative and creative in getting people into the care they need. As we started out by saying the first step is really engagement and a continuity relationship with a caregiver from this robust team. Thank you. Commissioners, other questions . I should also mention, i mean, we didnt talk much about theres a lot of work being done in h. I. V. And aids and taking the care to people experiencing homelessness. So i think we have a lot to learn from that team, the team that starting at positive Health Program ward 86, how can we take the care to the people who need it and then slowly engage them in ongoing primary care as well as specialty care. I think Zuckerberg San Francisco general, their Specialty Services are experts in providing that sort of care. I think actually it would be very interesting how with the director looking to see how its best to engage so that we get them to accept care first and get them to be able to obtain the expertise thats needed to really improve some very complicated cases. That would be very interesting. Thank you. Item 8 is the Human Resources update. Do you need any assistance getting the presentation up . Let me take a shot at it here. Good afternoon, commissioners. Im the dphr director. Im back with an update from the last presentation, and i believe it was in the spring. I had two people i was going to introduce to you, but they had to leave. One was rachael dan donju and then we have one analyst, his name is Nick Gonzalez and they helped me put together the data. Competing with the priority of this data, we did a3 which we did for the Employment Engagement survey which i helped to put together. We were finishing up epic and we had to create 5,000 what they call people of interest. It was the people side of the system so they could use epic. Then we finished the budget reconciliation. So this im comfortable with the data, but i know in the future, as we continue to do this, we can do better. All right. So the first thing we wanted to look at today was the employee Engagement Survey. What i wanted to point out about that was that in 2015 we did our first employee Engagement Survey. The Response Rate was 40 . So the Response Rate for this time around was 65 , which is a pretty incredible improvement. Im very happy with that. The question is what do we do with the information now that weve got it . So if you had a chance to look at the a3, i want to talk just briefly about that. So this is explaining somewhat in create detail what were going to do with the data. Its this document. Im not going to get into the details of that, but this is one of the tools well be using to make sure we have actionable results regarding the employee Engagement Survey. The a3 is used in lean process improvement. It states the background, conditions, and has attainable count countermeasures and deliverables. So weve worked, weve published this, shared it with the divisions. Then the divisions will come up with their own a3 regarding employee engagement. So our strengths were people like the work they do and people are comfortable referring to patients by whatever pronoun they request, even if it doesnt match their appearance. The top two areas we chose for improvement were Different Levels of the organization communicate effectively with each other was low and then adequate staffing was also low. But in the end, the ones we chose for the a3 were communication overall and equity. Now, the reason we chose that was that as we looked at the results, we noticed that on the questions of trust and general respect and disrespect, that things were rated differently. On over 96 of the questions, africanamericans gave the lowest percent of favorable scores compared to the rest of the organization. When it comes to the lowest scores, the values were, for example, employees from different becomes scored between 77 and 68 on questions that africanamericans averaged 49 . On trust and a work unit where others scored 49 , africanamericans scored 41 . These numbers are concerning and were working on it and taking it seriously. So the next steps for the employee Engagement Survey are, one, we are taking steps to ensure that the survey data is meaningful and analyzed properly and available. Well be doing oneonone meetings with divisions to ensure they can look at the data and creating a dashboard for their use as well. We have the oneonone consultations. Were doing webinars. Currently in the works is a letter to all staff about the survey, focusing on the areas that we talked about. And then developing for the next fiscal year, were developing an Effective Communication training, which would be crucial communications and training along that line. Then we go to hiring updates, which is another item we talked about. So we have what this shows is data for the d. P. H. Workforce. This is 1920 reflect data to date. For fiscal year 201819, we see that we are trending in the directions that we had hoped. So we 7,678 employees. One of the things i noticed when i got here when i first did the demographic report, we wanted to increase the number of africanamericans, and we did that going out to different conventions. So thats gone from 11. 22 to 12. 12 . Theres been a slight reduction in filipino employees or slight reduction in white employees. A slight increase in hispanic employees. And a slight rise in asian employees. So document two that i put in our packet which looks like this, so this in the years past we did demographic reports using pie charts in the past years we did demographic reports, so it would show by division, zuckerberg would show employees, asian, black, filipino, hispanic, and white. We were trying to see what does it look like. This is a more recent version of that and a little bit more detailed. It shows by unit that same sort of breakdown. So the idea with these in a division, they can look at these and say, okay, if we want to say match the 11 counties where we pulled our workforce from or match San Franciscos demographics, then we need to make some adjustments to how we hire. Thats what we would use this tool for and thats what we would ask managers to use the tool for. We cant set specific goals. Thats not allowed. I believe it was i think its not an initiative, but initiative 200 anyway, there was a lot that says you cant use this sort of information setting goals for hire. We can certainly use it as information. What we continue to do is have our recruiters reach out to areas where we need to improve. The other thing is to continue to get more involved in the hiring panels. What im finding is that it tends to be at the hiring panel level that we start to lose our diversity. Even if we get them onto the list, as they go through the panel process, we tend to lose those diverse candidates. Theres a couple remedies to that. The most drastic would be for us to say were going to have an established panel of three h. R. People, a hiring manager, and a subject matter expert. You would have three constant interviewers that would take out a lot of that bias people have whether they know it or not. This line, again getting back to some of the th